The proposed project is organized around the implementation of the 2006 PEPFAR guidelines for programs for "orphans and vulnerable children" (OVC) in South Africa. The specific aims of the research are as follows: (1) To describe how research and policy are translated, disseminated, and implemented by investigating the creation and implementation of the PEPFAR policy for OVC;(2) To track how organizations are shifting their procedures for defining and identifying eligible OVC in response to these guidelines;(3) To explore the extent to which the vulnerability and need of children enrolled in services are greater than that of other children in AIDS-affected communities;and (4) To understand the material and psychosocial effects on children of being classified as an OVC, or of being excluded from this category. The research is divided into two methodologically distinct sub-studies: (1) A multi-sited ethnography composed of (a) policy and archival research in the U.S.;(b) institutional ethnography of PEPFAR funded organizations in South Africa;and (c) in-depth ethnography with children and their families in rural South Africa and (2) Secondary data analysis of information from NGO service records for targeted children. Through its interdisciplinary methodology and its research aims, the research will contribute to the development of more effective programs for children affected by HIV/AIDS, to studies of implementation and dissemination, and to debates about the increasingly dominant role of large-scale, vertical public health programs in development aid and the "medicalization" of social ills and categories of eligibility. 2. The project focuses on a policy decision made by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) about how it defines the category of children eligible to receive services. The project aims to understand how the decision about which children to classify as "orphans and vulnerable children" (OVC), based in this case on an explicit link to HIV/AIDS, was made and how it affects the lives and experiences of individual children in rural South Africa. PUBLIC HEALTH RELEVANCE: As PEPFAR moves from a short-term "emergency" program to a more long-term vision, becoming an even more significant part of U.S. foreign aid, the project will contribute to research on how its policies and programs can most effectively serve AIDS-affected populations.